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Healthcare dilemmas in Bangladesh

  • Published at 04:42 pm June 16th, 2016
  • Last updated at 04:47 pm June 16th, 2016
Healthcare dilemmas in Bangladesh

The word hospital comes from the Latin "hospes," meaning a stranger or a foreigner to signify a guest. Another noun derived from this, "hospitium" stood for hospitality providing shelter, care, friendliness and hospitable reception. So care in hospitals is even given to a stranger who would be received with the honour of a guest and provided shelter in an atmosphere that is hospitable and friendly. Although the principle is laudable and is derived from the humane desire for caring for the sick, care in the modern era is complex, driven and multifactorial with cost of care, innovations, longevity, emergence of new illnesses and so on making this a complex system. It’s utilitarian rather than utopian and as such, acrimony and antagonism between health professionals and patients and their family is becoming a common occurrence.

Being on the receiving end of violent, abusive behaviour from patients and relatives is not uncommon in hospitals across the country. It is equally as common in public as well as private health care setups due to the gaping hole between the public's high expectations and existing health facilities. It is also not unusual for socio-politically motivated propaganda to feed and inflate this expectation without supporting and supplying the required resources to the health professionals at the fore-front of health care delivery.

Again, this phenomenon is not unique for Bangladesh. In the UK health care, National Health Service (NHS), there were 150 reported incidences of violence and aggression everyday. This not only burdens the system with financial loss but adversely effects the patient's experience, staff dissatisfaction, absenteeism and trust in the system.

The disappointment these patients and families feel stems from perceived inadequate, inappropriate, untimely or delayed care. If this is the case, it's the result of insufficient supply of resources (both human and material), overwork, expectation of care from health professionals beyond the limit of their skill and knowledge, and demand of care with little or no support. Over time, this leads to abuse that can range from social to psychological, eventually leading to disappointment and disillusionment among health professionals. It has come to a point where this may deter young people from considering pursuing a career in medicine and nursing.

Immediately on arrival, patients and relatives expect to be treated by the higher management. Every patient and their relatives feel that their need for medical attention is more important as such emotions are dictated by the pain, fear and uncertainty they feel while waiting for treatment. Emotions during traumatic and potentially life threatening situations is usually a complex admixture of physical, social and mental variables that run high. As a result, both patients and families are unlikely to be prepared to rationally manage those feelings.

Chronic exposure to such emotional stress may lead to tardiness, absenteeism, mistakes at work and work place conflict all leading to further patient dissatisfaction and increase in death and disability in hospitals. This is mostly because the responsibility of dealing with such highly charged situation falls squarely on the health professionals that are at the front line.

Hospitals are crowded with people of different psychae, pain and stress of disease or potential death, forced together by difficult circumstances. In such circumstances, prolonged waiting without appropriate information can be a difficult experience. For many, hospitals are uncomfortable and not a pleasant place to spend time at without any sense of progression. Hospitals are places often controlled by rules and regulations much of which is not obvious to non-medical people, where they may be experiencing extreme life events as well as witnessing many others who are just as distressed. From a patient’s perspective it can sometimes feel as if doctor's and nursing staff lack empathy. Patients and their family may perceive the work of hospital staff as non-essential, ignoring the essential task of caring for them. The root of violence originates from the perception, whether true or not, justifiable or imaginary, that doctors and or nurses are not prepared to give the care patients require and deserve. This may seem contrary to the real aims and objectives of many nurses and doctors and other health professionals who choose this career path with the motive to serve.

Failure of effective communication is a major cause behind such perception. Sometimes the perception reflects the fact genuinely and some healthcare professionals may show callousness towards patients’ distress. However, even if it may be true, particularly when doctors/nurses are expected to deal with situations beyond their ability or remit the fault should not fall only on the health professional or professionals involved, but should fall equally on the authority that employs such under-skilled personnel. In many cases though, the personnel involved may be fully aware of their own limitation or lack of it but are driven by greed to deliberately put themselves in that situation.

In order to avoid or at least reduce the incidence of violence in hospitals, the gap between patient's expectations and the care received has to be addressed in a systematic fashion. For decades, Bangladesh health care has been crying out for a sector wide human resource planning. Although http://dhakatribune.wpengine.com/feature/2016/06/16/ramadan-poetry/?preview=truethe policy makers have been fully aware of the need, very little progress has been made. In my previous articles on health, I have emphasised on the need for strategic workforce planning to deliver quality healthcare services.

We really can not create delays in developing a workforce that has the right capacity, skills, values and behaviours to meet future patient needs. The Ministry of Health andFamily Welfare published the Bangladesh Health Workforce Strategy in 2008 followed by the stakeholder dialogue with the objective of starting advocacy on the need for an adequate and skilled health workforce for a well-functioning health system. However, it has not been effective. I have been advocating the need for proper human resource development in stopping and even potentially reversing health tourism in other countries.